GADOLINIUM-BASED CONTRAST AGENTS IN PAEDIATRIC POPULATION: A REVIEW

Abstract

With the advancement of technology and development of magnetic resonance imaging, a major turning point in the field of radiology occurred in the twentieth century. Visualization of all parts of the human body was greatly facilitated while maintaining excellent spatial resolution without the use of ionizing radiation. In the pediatric population, this method is especially useful in the evaluation of the brain, thorax, abdomen, pelvis, and extremities. This is one of the first methods of choice for younger patients due to the non-use of ionizing radiation. Magnetic resonance contrast agents are used to increase the contrast of the obtained image and better resolution. The most used contrast agents include Gadolinium-Based Contrast Agents, whose first application took place in 1983. According to their molecular structure, they are divided into linear and macrocyclic, and in addition, they can be divided into ionic and nonionic. Macrocyclic compounds are generally considered safer due to the lower rate of dissociation of the free gadolinium ion, which is toxic in this form. Gadolinium-Based Contrast Agents have long been believed to be completely safe, but their association with nephrogenic systemic fibrosis was observed in the 2000s, after which the focus was on the use of macrocyclic compounds in pediatric patients for proven safety. In addition to the mentioned side effects, the development of acute allergic reactions is also possible, and more recently, findings on the deposition of gadolinium in tissues have been discovered. Despite the very low rate of all these side effects in pediatric patients, their long-term safety and use in the neonatal age has not yet been established. Precisely because of this, they should be applied with caution, with an emphasis on the application of the lowest possible doses, the use of macrocyclic chelates and a good risk assessment. This review paper collects and analyses so far published research on Gadolinium-Based Contrast Agents in the pediatric population